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General NPI Number Information
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NPI Number | 1083654537
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Entity Type | Individual
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Provider Name | SAMUEL NUNEZ LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 101 LIVINGSTON LOOP STE C1
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City | SANTA TERESA
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State | NM
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Zip | 88008-9753
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Country | US
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Telephone | 575-824-9000
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Fax | 866-596-6125
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Provider Business Mailing Address
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Address Line | PO BOX 1063
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City | SANTA TERESA
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State | NM
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Zip | 88008-1063
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Country | US
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Telephone | 575-824-9000
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Fax | 866-596-6125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | I-07343
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 02067
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License Number State | TX
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